Pettit made the connection. She diagnosed a rare fungal form of meningitis in a patient, thought it might be linked to a past spinal injection, and sent an email to the state Health Department.

Kainer found the cause. Responding immediately to Pettit’s email, she launched a probe, alerted federal health officials to the problem and led the team that pinpointed the culprit.

Without their actions, casualties from an outbreak that has sickened more than 650 people and killed 39 would surely have been much higher.

“They deserve so much praise and gratitude from the residents of Tennessee and beyond,” said Kathy Emery, director of online learning for Nashville State Community College, who read about the doctors’ heroic actions in The Tennessean and was moved to personally thank them.

'A hero to many'

Gilbert Foster, 67, of Nashville nominated Pettit for Tennessean of the Year.

“This doctor is truly a great Tennessean and a hero to many,” Foster said.

A native of Saginaw, Mich., and a medical school graduate from Wayne State University in Detroit, Pettit came to Nashville to do her internal medicine residency at Vanderbilt. A fellowship there, in infectious diseases, soon followed.

“When people asked me as a child, the first thing I always said was I wanted to be a doctor, so that was kind of always there,” she said. “As I grew older and realized what it meant to be a doctor, what I really enjoy is lifelong learning. The field is always changing and you’ve got to keep up with those changes.”

A private person who blushes easily, Pettit has given only a couple of media interviews. She has tried to shrug off all the attention she has received.

“It is overwhelming,” she said.

“I come to work every day where it’s nice to be recognized by your patients and your supervisors. To have recognition from outside your field and from the public is a big honor, but also definitely overwhelming.”

Besides stints at the medical center, she works at Vanderbilt Comprehensive Care Clinic, which specializes in HIV treatment.

Brad Beasley, director of the HIV prevention and control program for Metro Public Health, said he was not surprised when he learned about Pettit’s role in uncovering the meningitis outbreak.

He remembered a phone call from her months earlier about an HIV patient.

“She was astute in recognizing that something was really atypical regarding a patient, and she chased it down,” Beasley said. “That’s not to say other doctors don’t go the extra mile, but I think she does. She’s very thorough.”

Finding the culprit

The outbreak had nothing to do with HIV, although fungal meningitis is a rare disease that typically sickens only people with compromised immune systems. Pettit had an otherwise healthy patient in his 50s with meningitis.

She treated him with the standard antibacterial medications, then discharged him after his symptoms improved and routine bacterial cultures tested negative.

A week later, he came back to the hospital, sick again, so she prescribed intravenous antibiotics. His symptoms had returned, and worsened. She tried an antifungal medication on the sixth day of his hospitalization — one day before Aspergillus, a common mold, showed up in a spinal fluid culture that Vanderbilt lab technicians had been monitoring.

Although she had no proof, Pettit theorized that the rare disease was linked to an epidural her patient received as a pain treatment a month before he got sick.

“I just went back through the record and talked to the family a little more to try to find out any kind of way that the patient could have been exposed to this infection,” she said. “That was the only thing that turned up.”

He had gotten the spinal injection at Saint Thomas Outpatient Neurosurgery Center. Pettit sent an email to the Health Department on Sept. 18, answered Kainer’s questions and went back to tending to her patient.

She doubled down with a second antifungal medication. Despite her efforts, the patient died on his 22nd day in the hospital. She has kept his name confidential, but with his family’s permission wrote a report about his case history in the New England Journal of Medicine.

“Something often forgotten when something like this happens is there were real people involved that were ill and there were families involved,” Pettit said. “I think it is important to stop and remember that there were people who suffered and respect that.”

MRSA outbreak changed her career

State epidemiologist Dr. Tim F. Jones nominated Kainer for Tennessean of the Year.

“She led the team here that was first to recognize a nationwide outbreak that has ended up affecting hundreds of people in multiple states,” Jones said. “Her early and aggressive investigation has likely saved a huge number of lives.”

A woman of German heritage who grew up in Australia, Kainer began her journey to the United States some two decades ago, inside an Australian hospital where heart surgery patients were getting sick and she did not know how or why.

“In the 1990s I was involved in a horrific outbreak of MRSA (methicillin-resistant Staphylococcus aureus) sternal wounds that completely changed my career,” she said. “At that time, I felt completely powerless. I didn’t have the right tools on how to do that outbreak investigation and there was nobody I could ask for help. The local health department was great in doing food-borne investigation outbreaks but didn’t have the expertise in health-care-associated infections.”

Building on her medical degree from the University of Melbourne, she went back to college and got a master’s degree in public health in epidemiology from Monash University in Australia and applied for acceptance into the U.S. Centers for Disease Control and Prevention’s epidemic intelligence service.

The two-year program, which admits only 70 to 80 health care clinicians each year, accepted Kainer. During her tenure, she investigated a football team’s MRSA outbreak and fungal infections in women traced to saline breast implants. She worked on tuberculosis cases in Taiwan and neonatal infections in Egypt.

She experienced the thrill of touring the Great Pyramids on the back of a camel and the trepidation of being in Egypt on Sept. 11, 2001.

In 2003, she went to work for Tennessee as the director of health-care-associated infections and antimicrobial resistance program. She has worked with Tennessee hospitals as they have dramatically decreased the incidence of bloodstream infections. Kainer writes yearly reports that bring into public view the safety records for individual hospitals on health-care-associated infections.

Team gets to work

Kainer asserted authority from the beginning of the outbreak. On Sept. 18, the same day that Kainer talked to Pettit, she telephoned Candace Smith, the infection prevention specialist at Saint Thomas Hospital, and told her she considered the single illness a sentinel event — a medical term for an instance of harm to a patient in a health care setting that warrants an investigation.

Her team quickly ruled out the clinic space as the source of the contamination. Then she focused on the medicines and equipment used to administer the epidurals. She identified preservative-free methylprednisolone acetate made by New England Compounding Center as the leading suspect before tests by the U.S. Food and Drug Administration confirmed it as the source.

On Sept. 24, Kainer contacted the Massachusetts Department of Health about obtaining a distribution list of clinics that received the steroid medication from New England Compounding Center. Two days later, the company initiated a voluntary recall of the medicine.

The outbreak mushroomed into a national health care crisis. The moldy medicine had not only made Pettit’s patient sick with rare Aspergillus meningitis, it also had spawned a brand-new disease. Most of those sickened had Exserohilum meningitis, a disease that had never been diagnosed in humans before.

Kainer camped out in her office, sleeping on an exercise mat, for weeks. But responding to an outbreak is not a one-woman job.

Her team in Tennessee includes six staff members whose salaries are paid directly by the CDC. She said the outbreak shows why funding to the agency is vital to public health at the state level.

“I have an awesome team of people,” she said. “My team is fantastic.”

The team gave the CDC, the FDA and state health departments across the nation information that saved lives. Contaminated medicine was pulled from clinic and hospital shelves. Doctors developed treatment strategies. And infected people were able to get antifungal medications before it was too late.

But none of that would have happened if two very astute physicians — one trying to understand a patient’s sickness, another seeking to prevent similar illnesses — hadn’t moved forcefully to solve a deadly problem.